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The Pan American Health Organization, one of the oldest international health bodies in the world, seems to be playing a minor role in the current COVID-19 crisis, despite the epicenter of the disease is in the Western Hemisphere. 

As of today – May 29, 2020 – six out of the 15 worst hit countries by the virus are located either in North America or South America. The top two in the region – and the world – are the United States – with 1,750,000 confirmed cases and more than a 102,000 deaths; and Brazil, rapidly approaching half a million cases with 28,000 deaths. Peru, with 142,000 cases – and more than 4,000 deaths; Canada with 90,910 cases – and more than 7,000 deaths; Chile, with almost 91,000 cases – and around 950 deaths; and Mexico, with 85,000 cases and around 950 deaths, complete the picture.

The above mentioned countries have faced COVID-19 with different strategies. Skepticism was shown from the beginning of the pandemic by both U.S. President Donald Trump and Brazilian President Jair Bolsonaro. Both minimized the disease and were reluctant to adopt a quarantine. The United States, where the first confirmed case was detected on January 20, and Brazil where the first man with COVID-19 tested positive on February 25, acted slowly. Their Presidents collided with regional governors over the most appropriate measures to prevent the coronavirus from spreading and contributed to a major health and social crisis in their respective countries. 

Canada, whose first case was confirmed on January 27, has shown large regional disparities when it comes to the virus, with Quebec the worst hit with more than half of all cases in the country. Peru and Chile have bet on testing, which provided the two countries with epidemiological intelligence to spot the most vulnerable regions, applying containment and mitigation measures. These help explain the slow lethality rate thus far. This is more visible in the Chilean case, with less than a thousand deaths, despite the virus arriving in the country on March 3. 

Mexico, instead, upon arrival of the virus on February 28, has acted slowly, without massive testing – thus ignoring the hot spots of the virus throughout the country and, in consequence, has the worst lethality rate in the Western Hemisphere – 11.11 percent.

What role was PAHO played in this crisis? Based in Washington D. C., PAHO was born in December 1902. In 1870, a major yellow fever outbreak in Argentina, Brazil, Paraguay, and Uruguay later spread to the United States due to growing maritime transportation. This prompted countries to work on the prevention and contention of diseases. The construction of the Panama Canal was another milestone since the original project, endorsed by France, was later dropped, partly because of high mortality rates of workers due to malaria. When the United States decided to go ahead – between 1904 and 1914 – with the canal it needed a health strategy to overcome the disease.

Since its birth, PAHO has been instrumental in the development of health diplomacy in the Americas. In 1924, 18 countries signed on during the Seven Pan American Sanitary Conference held in Cuba. The Pan American Sanitary Code is still in force today. This code is rooted in the recognition that collective measures are needed in the face of diseases. Yet, the emphasis on avoiding unnecessary measures that prevent trade from developing is noteworthy in the code.

Today the membership stands at 52 countries and territories.

PAHO provides technical cooperation to fight communicable and non-communicable diseases and, at the same time, promotes the strengthening of public health in the Americas. Yet, these tasks require leadership, and therein lies the problem today in dealing with COVID-19. Despite having a director, PAHO requires political consensus coming from its members towards a common strategy in dealing with the COVID-19 pandemic. Dr. Carissa F. Etienne from Dominica has been ratified for a second five-year term as head of the institution. 

To start with, health issues are not relevant for the Donald Trump Administration. This is in stark contrast to Barack Obama Administration, which considered health issues a priority. This included not only the Patient Protection and Affordable Care Act, better known as ObamaCare, but his reaction when the A H1N1 influenza, Ebola and Zika outbreaks developed. Health was on the agenda at that time. 

President Trump has distanced himself from the Obama initiatives and, despite being the worst hit country in the entire world by COVID-19, he has at all times minimized its relevance, not only by suggesting injections of disinfectant to beat the virus, but most important, by taking personal every criticism about the disease, since he is looking for reelection. His most recent move was the “termination” of the relationship between the U.S. and the World Health Organization (WHO). The meaning of this is, at this time, unclear and many experts have suggested the president doesn’t have the authority to disengage, not only because it is the worst possible time to do so. His decision interferes with the searching of a vaccine that Americans and millions of people around the world need. With this decision Trump also destroys health diplomacy efforts. 

Now, let’s take a look at the Americas. When Trump talk about the “termination” of the U.S. relationship with WHO, he also mentioned that money spent on the international body would be redirected to “other worldwide and deserving urgent global public health needs.” Does this mean PAHO will get more funding? Is it possible that, because the Americas is the epicenter of COVID-19, the Trump Administration will use the money intended for the WHO to improve the crisis-response of PAHO and Latin American and Caribbean countries?

To event think about that, Latin American and Caribbean countries may need a more coherent view on COVID-19. No country in the Western Hemisphere has been able to “flatten the curve,” not even Canada, which has the best health system in the entire region. As mentioned before, Bolsonaro, president of the most important Latin American country, has denied the relevance of the virus; has lost two health ministers – one was fired and the other one just resigned – in the middle of the crisis; has collided with provincial governors on the quarantine and so on. More important, Brazil has borders with all South American countries but Chile, meaning his “never mind” policies could have devastating effects in neighboring countries.

How about Mexico? With just a bunch of tests in place – cases and fatalities have dramatically increased whereas less and less tests are conducted – the country will re-start some economic activities on June 1. Indeed, President Andrés Manuel López Obrador has announced that he will tour again the country. Business as usual, although Mexico has not even reached the peak of the disease, with health experts predicting this will occur by the end of June.

Alberto Fernández’s Argentina has gained international attention for what is perceived as a successful containment and mitigation policy – as opposed to Bolsonaro’s Brazil – since the country has around 15,500 cases and only 524 deaths. Yet, Chile, its neighbor, with a third of Argentina’s population and six times more confirmed cases, claims Fernandez is not testing enough. If you don’t test, you don’t have cases, Chilean health authorities say. 

Yet, Fernandez moved fast to close Argentina’s borders and established a mandatory national quarantine. He also announced a package of economic measures for the benefit of unemployed and the poor. This hah happened at a time when Argentina faces a critical economic situation. Yet his country seems better equipped politically and socially to to respond to the health challenge, as compared to Chile, which last year faced social and political turmoil, with President Sebastián Piñera facing criticism over the economic policies of his government. 

It is difficult to see a united Latin America against the COVID-19. One may take a look at the recent process to choose the head of the Organization of American States (OAS) on March 20, which led to the reelection of Luis Almagro, whose candidacy was endorsed by the United States, Brazil, Colombia, Chile, Ecuador, Guatemala, Panama, Bolivia, Haiti and Uruguay among others. Mexico and Argentina supported María Fernanda Espinosa. At the end of the election process, Almagro secured 23 votes while Espinosa only picked up ten.

The OAS – of which PAHO is a key component as part of the Inter American System architecture to which the two belong – shows a highly divided region. Part of the problem is clearly a lack of leadership. During the Obama Administration, relations between the US and Cuba were re-established. And, yes, there was a clear policy – though criticized by left-wing governments throughout the region – toward Venezuela. Obama himself shook hands with Cuban President Raúl Castro in a much-publicized image around the globe. 

Instead, during the Trump Administration, Latin American doesn’t seem to exist, apart from Mexico and Brazil. Mexico has been front and center due to the negotiation of the United States-Mexico-Canada trade pact, which replaces the 1994 North American Free Trade Agreement. Brazilian President Bolsonaro has met with Trump in Washington, D.C. During the 8th Americas Summit held in Peru in 2018, President Trump didn’t attend and sent Vice President Mike Pence instead. 

The situation in Venezuela, where Juan Guaidó has looked for support from the international community to replace Nicolás Maduro, has been of little interest to Trump, provided the issue stays far from the U.S. border. It was not the same when Mexico offered political asylum to former Bolivian President Evo Morales. Allowing Morales to enter Mexico made the Trump administration so uncomfortable that the American national prosecutor met with President López Obrador and asked him to expel Morales. Thus, Mexico facilitated the departure of Morales to Cuba. From there, the Bolivian politician waited for Alberto Fernández to become president of Argentina, so that he could fly there, very close to his motherland under the protection of a left-wing government. Of course, this has created frictions between Argentina and its neighbors, starting with Brazil. By the way, when Fernández became President, Bolsonaro didn’t attend the ceremony. Previously, when the news about Fernández winning the presidential elections in Argentina were confirmed, Bolsonaro said the Argentinians made a terrible mistake by electing the peronists.

With that background in mind is hard to imagine a Latin American or a Western Hemispheric common front to fight COVID-19. It is believed that, at critical times, leadership flourishes. This is in fact happening in Europe, where under the leadership of Germany’s Angela Merkel, the European Union is working on common health strategies, that, to many observers, may lead to a re-launching of the economic integration process, recently harmed due to the BREXIT crisis. 

In sharp contrast to Europe, Latin American countries seem more divided than ever, at a time when research, expertise and cooperation is much needed to survive the pandemic. Health diplomacy should prevail, despite the political orientation of the Latin American – and American- governments – after all, that is what diplomacy is about, right? 

This is of critical importance today, when it is clear the Trump Administration is against multilateralism and not very fond of health diplomacy. PAHO has stated that $94.8 million are needed at this time to support efforts in countries much in need of help until September 2020. Apart from that, PAHO provides a platform with information that may help at this critical juncture, to battle infodemic and misinformation about the disease, as well as communication through technology, at a time when physical social interaction is limited. 

Since WHO has warned about a second wave of the disease, it is important to act and learn quickly since there’s a long way to to go before the curve is flattened during this first wave of coronavirus. And it is perceived that PAHO could and should do more. But, will Trump make the call?

Editor’s Note: The above guest column was penned by author, economist and researcher Maria Cristina Rosas and appears in The Rio Grande Guardian with her permission. Rosas is currently based at the Department of International Relations of the National Autonomous University of Mexico in Mexico City. She can be reached at [email protected]

Editor’s Note: The main image accompanying the above guest column shows the Washington, D.C., headquarters of the Pan American Health Organization. (Photo: Flickr)


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